Mobile, awake and critically ill

Herridge, Margaret S.

doi:10.1503/cmaj.080178

Cited by 16 publications

(9 citation statements)

References 23 publications

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“…In the past, routine features of general care provided in the ICU included liberal use of sedation and immobilization of the patient, which were thought to be necessary for facilitating interventions to normalize physiological function by artificial means. Over the last decade, there has been a paradigm shift away from this approach towards a more conservative treatment philosophy for patients in the ICU [4,6,7]. This paradigm shift is consistent with the observation that long-term physical problems in survivors of critical illness, particularly those with respiratory failure, may result from the protracted ICU stay and period of immobilization during which the patient is receiving organ support that is essential for survival [2,4].…”

Section: Introductionmentioning

confidence: 74%

Functional Electrical Stimulation‐Assisted Cycle Ergometry in Critically Ill. Protocol of Randomised Controlled Trial

Waldauf

Gojda

Urban³

et al. 2019

Preprint

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Intensive care unit-acquired weakness is the most important cause of failed functional outcome in survivors of critical care. Most damage occurs during the first week when patients are not cooperative enough with conventional rehabilitation. Functional-electrical stimulation-assisted cycle ergometry (FES-CE) applied within 48 of ICU admission may improve muscle function and long-tem outcome. Methods: Assessor-blinded pragmatic single-centre randomized controlled trial. Adults (n=150) mechanically ventilated for <48 hours from 4 ICUs who are estimated to need >7 days of critical care will be randomized (1:1) to receive either standard of care or FES-CE-based intensified rehabilitation, which will continue until ICU discharge. Primary outcome: Quality of life measured by SF-36 score at 6 months. Secondary outcomes: functional performance at ICU discharge, muscle mass (vastus ultrasound, N-balance) and function (MRC score, insulin sensitivity). In a subgroup (n=30) we will assess insulin sensitivity and perform skeletal muscle biopsies to look at mitochondrial function, fibre typing and regulatory proteins expression.

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Section: Introductionmentioning

confidence: 74%

Functional Electrical Stimulation‐Assisted Cycle Ergometry in Critically Ill. Protocol of Randomised Controlled Trial

Waldauf

Gojda

Urban³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…In the past, routine features of general care provided in the ICU included liberal use of sedation and immobilization of the patient, which were thought to be necessary for facilitating interventions to normalize physiological function by artificial means. Over the last decade, there has been a paradigm shift away from this approach towards a more conservative treatment philosophy for patients in the ICU [4, 6, 7]. This paradigm shift is consistent with the observation that long-term physical problems in survivors of critical illness, particularly those with respiratory failure, may result from the protracted ICU stay and period of immobilization during which the patient is receiving organ support that is essential for survival [2, 4].…”

Section: Introductionmentioning

confidence: 99%

Functional electrical stimulation-assisted cycle ergometry in the critically ill: protocol for a randomized controlled trial

Waldauf

Gojda

Urban

et al. 2019

Trials

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BackgroundIntensive care unit (ICU)-acquired weakness is the most important cause of failed functional outcome in survivors of critical care. Most damage occurs during the first week when patients are not cooperative enough with conventional rehabilitation. Functional electrical stimulation-assisted cycle ergometry (FES-CE) applied within 48 h of ICU admission may improve muscle function and long-term outcome.MethodsAn assessor-blinded, pragmatic, single-centre randomized controlled trial will be performed. Adults (n = 150) mechanically ventilated for < 48 h from four ICUs who are estimated to need > 7 days of critical care will be randomized (1:1) to receive either standard of care or FES-CE-based intensified rehabilitation, which will continue until ICU discharge. Primary outcome: quality of life measured by 36-Item Short Form Health Survey score at 6 months. Secondary outcomes: functional performance at ICU discharge, muscle mass (vastus ultrasound, N-balance) and function (Medical Research Council score, insulin sensitivity). In a subgroup (n = 30) we will assess insulin sensitivity and perform skeletal muscle biopsies to look at mitochondrial function, fibre typing and regulatory protein expression.Trial registrationClinicalTrials.gov, NCT02864745. Registered on 12 August 2016.

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“…Management of critically ill patients has traditionally involved periods of immobility, bed rest, use of analgesics and sedative medication [ 1 ]. This traditional model of practice has been geared to promote patient comfort, safety, respiratory synchrony and mechanical ventilatory support for severe respiratory failure [ 2 ]. Physiotherapy plays a pivotal role in the rehabilitation of intensive care unit (ICU) patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest, which is further exacerbated in individuals with critical illness [ 13 ]. Both CIP and CIM have been reported to delay weaning, compromising rehabilitation, leading to increased hospital and ICU morbidity and mortality [ 2 , 7 , 14 ]. The weakness has also been found to be associated with adverse long-term outcomes like functional status and quality of life of these patients [ 2 , 7 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Both CIP and CIM have been reported to delay weaning, compromising rehabilitation, leading to increased hospital and ICU morbidity and mortality [ 2 , 7 , 14 ]. The weakness has also been found to be associated with adverse long-term outcomes like functional status and quality of life of these patients [ 2 , 7 , 14 ]. Knowledge of the effects of prolonged bed rest on multiple body systems and its association with long-term outcomes of the patients has resulted in changes in standard clinical practice [ 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of the physical function ICU test tool in a resource constrained intensive care unit to promote early mobilisation of critically ill patients- a feasibility study

Tadyanemhandu

Manie

2016

Arch Physiother

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BackgroundThe shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. The aim of this study was to determine the feasibility of an early mobilisation program and to report on the changes in patient clinical outcomes following the intervention in a low income country.MethodsA prospective cohort study was carried out at one public hospital. An adult cohort of 35 patients was recruited within 24 h of being admitted into the unit, irrespective of ventilation method over a period of three months. An early mobilisation programme was implemented and prescribed using the Physical Function ICU Test (PFIT-s) which commenced in either the ICU or high dependent unit.ResultsThe median age of the 35 patients was 29 years (IQR = 24–45 years). More than half of the patients had undergone surgery due to either gastrointestinal problems or obstetrical complications. A total of 94 out of a possible of 219 exercise sessions were delivered to the patients (43.0 %). The tool was implemented in 32 (91.4 %) patients on the initial PFIT-s measurement and 16 (45.7 %) of the patients required the assistance of two people to stand. The Initial PFIT-s mean score was 5.3 ± 1.8. On final PFIT-s measurement, out of the 30 (85.7 %) patients seen, 15 (42.9 %) of the patients did not require any assistance to stand and the final PFIT-s mean score was 7.0 ± 1.9. There was a significant difference in both the initial PFIT-s total score (t-value = 2.34, df = 30, p = .03) and the final PFIT-s score (t-value = 3.66, df = 28, p = .001) between males and females. During the treatment, no adverse event occurred in any of the patients.ConclusionAn early mobilisation program using PFIT-s was feasible and safe. There was a difference in functional capability based on gender, with males being more functionally active. Specific inclusion and exclusion criteria can lead to a delayed early mobilisation activities in ICU patients.Trial registrationPan African Clinical Trials Registry PACTR201408000829202. Registered 15 August 2014.

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Mobile, awake and critically ill

Cited by 16 publications

References 23 publications

Functional Electrical Stimulation‐Assisted Cycle Ergometry in Critically Ill. Protocol of Randomised Controlled Trial

Functional Electrical Stimulation‐Assisted Cycle Ergometry in Critically Ill. Protocol of Randomised Controlled Trial

Functional electrical stimulation-assisted cycle ergometry in the critically ill: protocol for a randomized controlled trial

Implementation of the physical function ICU test tool in a resource constrained intensive care unit to promote early mobilisation of critically ill patients- a feasibility study

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